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Real-world utilisation of ASCT in multiple myeloma (MM): a report from the Australian and New Zealand myeloma and related diseases registry (MRDR)

Bone Marrow Transplantation volume 56, pages 2533–2543 (2021)Cite this article

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Abstract

Supported by clinical trial proven survival benefit, clinical guidelines recommend upfront autologous stem cell transplantation (ASCT) for eligible MM patients. However, reported real-world utilisation is lower than expected (40–60%). We reviewed ASCT utilisation, demographics and outcomes for MM patients (≤70 years, ≥12-month follow-up) enroled onto the Australian/New Zealand MRDR from June 2012 to May 2020. In 982 patients (<65 years: 684, 65–70 years: 298), ASCT utilisation was 76% overall (<65 years: 83%, 65–70 years: 61%, front-line therapy: 67%). Non-ASCT recipients were older (median age: 65 years vs 60 years, p < 0.001), had more comorbidities (cardiac disease: 16.9% vs 5.4%, p < 0.001; diabetes: 19.1% vs 7.0%, p < 0.001; renal dysfunction: median eGFR(ml/min): 68 vs 80, p < 0.001), inferior performance status (ECOG ≥ 2: 26% vs 13%, p < 0.001) and higher-risk MM (ISS-3: 37% vs 26%, p = 0.009, R-ISS-3 18.6% vs 11.8%, p = 0.051) than ASCT recipients. ASCT survival benefit (median progression-free survival (PFS): 45.3 months vs 35.2 months, p < 0.001; overall survival (OS): NR vs 64.0 months, p < 0.001) was maintained irrespective of age (<65 years: median PFS: 45.3 months vs 37.7 months, p = 0.04, OS: NR vs 68.2 months, p = 0.002; 65–70 years: median PFS: 46.7 months vs 29.2 months, p < 0.001, OS: 76.9 months vs 55.6 months, p = 0.005). This large, real-world cohort reaffirms ASCT survival benefit, including in ‘older’ patients necessitating well-designed studies evaluating ASCT in ‘older’ MM to inform evidence-based patient selection.

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Fig. 1
Fig. 2: Progression-free survival.
Fig. 3: Overall survival.

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Acknowledgements

The authors thank the patients, hospitals, clinicians, and research staff at participating institutions for their support of the MRDR. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors; however, the ANZ MRDR has received funding from Amgen, Bristol-Myers Squibb, Celgene, Gilead, Janssen, Novartis, Sanofi and Takeda.

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Authors and Affiliations

  1. Alfred Health-Monash University, Melbourne, VIC, Australia

    Krystal Bergin & Andrew Spencer

  2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Cameron Wellard, Elizabeth Moore, Zoe McQuilten & Erica Wood

  3. Sir Charles Gairdner Hospital, Perth, WA, Australia

    Bradley Augustson

  4. Northern Health, Melbourne, VIC, Australia

    Rachel Cooke

  5. Middlemore Hospital, Auckland, New Zealand

    Hilary Blacklock

  6. Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, VIC, Australia

    Simon J. Harrison

  7. Sir Peter MacCallum Dept of Oncology, Melbourne University, Melbourne, VIC, Australia

    Simon J. Harrison

  8. Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Joy Ho & Tracy King

  9. St.Vincent’s Hospital, Melbourne, VIC, Australia

    Hang Quach

  10. Princess Alexandra Hospital and University of Queensland, Brisbane, QLD, Australia

    Peter Mollee

  11. Peninsula Health, Frankston, VIC, Australia

    Patricia Walker

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Bergin, K., Wellard, C., Augustson, B. et al. Real-world utilisation of ASCT in multiple myeloma (MM): a report from the Australian and New Zealand myeloma and related diseases registry (MRDR). Bone Marrow Transplant 56, 2533–2543 (2021). https://doi.org/10.1038/s41409-021-01308-8

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